Adenomyosis happens when cells from the uterine lining move into the uterine wall. These cells react to hormones like oestrogen and progesterone, causing them to grow and bleed slightly within the muscle tissue each month. It leads to an enlarged uterus and heavy periods. While ultrasound can help diagnose it, MRI scans provide more accuracy. Medical treatments often control the bleeding effectively.
What Causes Adenomyosis?
The exact cause of adenomyosis remains unknown, but genetics and certain hormones play a pivotal role. Contraceptive pills or coils do not contribute to the development of adenomyosis.
Around 20% of women visiting gynaecology clinics have adenomyosis. It is most predominant in women in their 40s and 50s, those who have previously been pregnant, and women with endometriosis.
(Endometriosis occurs when the cells lining the womb grow outside it, such as on the ovaries or fallopian tubes.)
What Are the Symptoms of Adenomyosis?
Adenomyosis, a common but often overlooked condition, occurs when the uterine lining penetrates the muscle wall, causing the uterus to enlarge. While symptoms can vary, many women may experience no symptoms at all.
Here are some key symptoms of adenomyosis, which can lead to intense period pain and cramping:
- Heavy and painful periods
- A noticeable lump in the lower abdomen due to an enlarged uterus
- Frequent urination and constipation, as the enlarged uterus can press against the bladder and bowel
During menstruation, the adenomyotic tissue swells and bleeds within the uterine wall, adding to the uterine lining and causing severe pain, cramping, and heavy periods.
Other common causes of heavy and painful periods include fibroids and endometriosis, which often co-exist with adenomyosis. In fact, adenomyosis is sometimes referred to as internal endometriosis because, while the uterine lining grows inside the uterine wall with adenomyosis, it grows outside the uterus in endometriosis.
How is adenomyosis diagnosed?
Diagnosing adenomyosis can be challenging since many of its symptoms are common and experienced by numerous women. A significant number endure heavy and painful periods, often dismissing these signs as usual. Many women are unaware of how heavy or painful their periods should actually be.
Doctors typically identify adenomyosis through an ultrasound or MRI scan, where the uterus appears enlarged, and one wall is noticeably thicker than the other.
You may consider your periods heavy if you are passing large clots, constantly using double protection, needing to change protection more frequently than every four hours, or if your periods are causing anaemia. It is worth consulting aprivate gynaecologist in London for a thorough evaluation.
Best Adenomyosis Treatment in London
Adenomyosis treatment depends on factors such as age, fertility goals, symptoms, co-existing conditions, and symptom severity.
Some women may have both endometriosis and adenomyosis, while others may also have fibroids.
During an ultrasound scan, doctors sometimes face challenges distinguishing between adenomyosis and fibroids. Some women develop well-defined adenomyomas, which are balls of adenomyosis within the uterine muscle. These abnormalities are often only identified during surgery.
Surgeons may encounter difficulty removing fibroids, as distinguishing between the fibroid mass and normal uterine tissue can be problematic.
Medical Treatment
- Painkillers
Gynaecologists often prescribe non-hormonal options like Mefenamic Acid for women with painful periods. This painkiller relieves pain and reduces heavy bleeding. Women trying to conceive can safely use these medications.
2. Hormonal Treatments
- Oral contraceptive pills
- Progesterone-only pills
- Mirena intrauterine system: This system significantly reduces pain and bleeding in up to 72% of women over three years, particularly in those whose periods stop due to its use.
- GnRH Agonists: These agents are potent but limited to short-term use due to risks such as osteoporosis and hot flushes.
Surgical Options
- Endometrial Ablation or Transcervical Resection of Endometrium
For women with heavy periods, these procedures remove the uterus lining, reducing pain in 30-50% of women and heavy bleeding in up to 70%. However, women with adenomyosis face a 1.5 times higher risk of procedure failure. If the initial treatment is ineffective, a gynaecologist typically suggests a hysterectomy.
2. Laparoscopic Adenomyomectomy
This surgery aims to remove adenomyosis, similar to fibroid removal. Experts typically offer it to younger women with severe pain who have not completed their families. However, adenomyosis may recur if some tissue is left behind. Doctors often recommend a few months of GnRH therapy after surgery to lower the risk of recurrence.
Fertility Post-Surgery
Limited evidence suggests that adenomyomectomy might improve fertility. A small study of 71 women reported a 70% pregnancy rate along with improved symptoms of painful and heavy periods.
Hysterectomy
Hysterectomy is the preferred treatment for women who have completed their families and continue to experience heavy periods and pain from adenomyosis. It guarantees the end of menstrual periods, although non-menstrual pain may persist. The laparoscopic approach is favoured as it allows doctors to inspect the pelvis for other abnormalities.
Uterine Artery Embolisation
This procedure is gaining popularity among women seeking an alternative to hysterectomy. With a 70% satisfaction rate, it is an increasingly viable option for managing adenomyosis.
Whether seeking medical, surgical, or alternative treatments, patients can find personalised care for adenomyosis treatment in London, ensuring relief from symptoms and improved quality of life.
Our Final Verdict
Adenomyosis occurs when endometrial tissue grows within the uterine muscle, making it a familiar yet challenging gynaecological condition. Its symptoms can severely affect your quality of life, but diagnosis can be difficult due to similarities with other conditions and the limitations of current diagnostic tools. Treatment options vary from conservative methods to surgery, depending on the severity of symptoms and your reproductive goals. Raising awareness, advancing diagnostic techniques, and providing tailored treatment plans are essential for managing adenomyosis and enhancing the quality of life for women affected by this condition. Consulting a knowledgeablegynaecologist in London can ensure access to the best treatment options.
FAQs
Q1) Is it dangerous?
Adenomyosis is a benign condition, meaning it isn’t pre-cancerous. While it can cause bothersome symptoms, it doesn’t pose a risk of adverse illness or death.
Q2) Will this affect my fertility?
There’s no evidence to suggest that adenomyosis affects natural conception. However, some recent studies indicate it might reduce the chances of successful fertility treatments in women who struggle to conceive naturally.
Q3) Do I need to do anything if I have no symptoms?
No, you don’t need treatment if you have no symptoms, even if a scan suggests you may have adenomyosis.
Q4) How is adenomyosis diagnosed?
Doctors use transvaginal ultrasound (TVUS) or magnetic resonance imaging (MRI) to diagnose adenomyosis, neither of which involves radiation. Since ultrasound is more widely available, it’s usually the first diagnostic method. Research shows that the more ultrasound features of adenomyosis you have, the more severe your symptoms are likely to be.
Q5) What are the treatments that can alleviate adenomyosis symptoms?
If the pain isn’t long-standing, treatments like the Mirena coil, Cerazette, uterine artery embolisation, or hysterectomy can fully relieve symptoms.
It’s also common, particularly in thinner women, to feel bloated and have a distended tummy during the second half of the cycle due to progesterone produced after ovulation.